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Dentigerous cyst is a developmental odontogenic cyst, which apparently develops by accumulation of fluid between reduced enamel epithelium and the tooth crown of an unerupted tooth. Dentigerous cyst associated with supernumerary tooth and mesiodens is rare. The usual age of clinical presentation of dentigerous cyst due to supernumerary tooth is during the first four decades. We report a rare case of dentigerous cyst in association with mesiodens in a young male
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ISSN 0975-8437 INTERNATIONAL JOURNAL OF DENTAL CLINICS 2011:3(1):77-78
©INTERNATIONAL JOURNAL OF DENTAL CLINICS VOLUME 3 ISSUE 1 JANUARY-MARCH 2011 77
Dentigerous Cyst Associated With Mesiodens: A Rare Case Report Chandramani.B.More., Hetul Patel
Abstract
Dentigerous cyst is a developmental odontogenic cyst, which apparently develops by accumulation
of fluid between reduced enamel epithelium and the tooth crown of an unerupted tooth. Dentigerous cyst
associated with supernumerary tooth and mesiodens is rare. The usual age of clinical presentation of
dentigerous cyst due to supernumerary tooth is during the first four decades. We report a rare case of
dentigerous cyst in association with mesiodens in a young male.
Key Words: Dentigerous Cyst;Mesiodens;Odontogenic Cyst;Supernumerary Tooth
Received on: 13/ 09/2010 Accepted on: 13/10/2010
Introduction
Dentigerous simply means ‘containing
teeth’.(1) A dentigerous cyst is one which
encloses the crown of an unerupted tooth by
expansion of its follicle and is attached to the
neck.(2) Dentigerous cysts are the most common
benign odontogenic cysts of developmental type
that are usually single in occurrence. However
multiple dentigerous cysts are also reported.
They are usually associated with an impacted
tooth and develop after the complete formation
of the crown. They most commonly involve the
mandibular third molars or the maxillary canine,
followed by the mandibular premolars. The
involvement of incisors and supernumerary teeth
are rare.(3) This paper report a rare case of
dentigerous cyst in association with mesiodens in
a young male.
Case Report
A healthy boy of sixteen years
presented with a chief complaint of painful
swelling on the right side of the face since 8-10
days. Initially the swelling was small with
occasional dull pain. The swelling and pain had
gradually increased leading to discomfort. His
systemic history, trauma and family history were
not significant. Extra oral examination showed
gross asymmetry of the face due to the swelling
on the right side. The swelling was hard, diffuse,
tender and of ovoid shape approximately
measuring around 4cm x 5cm extending from
midline and right lateral wall of the nose, mildly
obliterating the nasolabial fold and philtrum of
the lip to about 1 cm inferior to the infraorbital
margin and outer canthus of the eye. Mild
obliteration of right nare was observed. The lips
were incompetent. The right submandibular
lymph node was palpable and tender. Intra-oral
examination revealed a well-defined hard, tender
and ovoid swelling involving labial and palatal
aspect of right central incisor to second premolar
with labial and palatal cortical plates expansion
leading to obliteration of labial vestibule.
Palatally, the swelling extended from palatal
rugae and palatal gingiva to the center of the
hard palate approximately measuring 3x2.5 cm.
There were no visible or palpable pulsations. All
the involved teeth were vital and tender. Based
on the history and clinical examination, a
provisional diagnosis of Radicular cyst involving
11, 12 and 13 was established.
The differential diagnosis of dentigerous
cyst with an impacted supernumerary tooth was
considered. Routine laboratory parameters were
normal. FNAC of the swelling showed straw
coloured brownish fluid and on Cytologic
examination nonspecific inflammatory cells were
noted. Intra oral periapical radiograph, cross-
sectional occlusal view (Fig 1) and panoramic
radiograph showed a well-defined and unilocular
radiolucent lesion approximately measuring
4x3.5 cm, attached to the crown of the unerupted
inverted mesiodens in the right alveolar process
of the anterior maxilla. Also a supernumerary
tooth was noted on the left side of the palate.
This radiographic appearance suggested a
diagnosis of dentigerous cyst associated with
mesiodens.
Figure 1 Occlusal view Figure 2 CT
Non contrast CT in axial and coronal
planes showed fluid filled unilocular lesion along
with crown of mesiodens in the maxillary
alveolar process (Fig 2). The Surgical resection
of the lesion along with removal of mesiodens
CASE REPORT
ISSN 0975-8437 INTERNATIONAL JOURNAL OF DENTAL CLINICS 2011:3(1):77-78
©INTERNATIONAL JOURNAL OF DENTAL CLINICS VOLUME 3 ISSUE 1 JANUARY-MARCH 2011 78
and histopathological examination (Fig 3)
confirmed the diagnosis of dentigerous cyst
associated with mesiodens. The patient is under
follow up since six months and no complications
are observed.
Figure 7- Photomicrograph (HandE stained
specimen with x 10 magnification)
Discussion
A dentigerous cyst can be defined as
one that encloses the crown of an unerupted
tooth by expansion of its follicle and is attached
to its neck. They account for more than 24% of
jaw cysts.(4)The substantial majority of
dentigerous cysts involves the mandibular third
molar and the maxillary permanent canine,
followed by the mandibular premolars, maxillary
third molars and rarely the central incisors,
supernumerary teeth and mesiodens.(2)
Dentigerous cyst most commonly occurs in
second and third decade of life.
Daley and Winsock have recommended
the following guidelines for the diagnosis of a
dentigerous cyst: 1) a Pericoronal radiolucency
>4 mm in greatest width, 2) histologically,
fibrous tissue lined by nonkeratinized stratified
squamous epithelium and 3) a surgically
demonstrable cystic space between the enamel
and the overlying tissue. Of these, the third is the
most critical, but all the three must be
satisfied.(4)
Mesiodens is known to have a cone
shaped crown and a short root as seen in our
patient. It is a rare entity with a reported
incidence of 0.15 to 1.9% and has a slight male
predominance. Most mesiodens are located
palatally to the permanent incisors. Only a few
lie in the dental arch or labially to the permanent
incisors. Resorption of the adjacent roots by
mesiodens or its cyst is a rare complication. (5)
Dentigerous cyst is one of the most
common developmental odontogenic cysts which
is usually detected on routine radiographic
examination. Developing dentigerous cyst is
difficult to distinguish from normal follicle. The
pericoronal radiolucencies more than 4 mm
should be considered cystic, until proven
otherwise.(6)
Conclusion
Dentigerous cyst rarely involves central
incisors, supernumerary teeth and mesiodens.
The diagnostic feature of this cyst is the presence
of unerupted / impacted tooth in its cavity. Authors Affiliations: 1. Dr. Chandramani.B.More,
M.D.S, Professor & Head, 2. Dr. Hetul. J. Patel,
Department of Oral Medicine & Radiology, K. M.
Shah Dental College & Hospital, Sumandeep
University, Gujarat, India.
References 1. Ustuner E, Fitoz S, Atasoy C, Erden I, Akyar S.
Bilateral maxillary dentigerous cysts: a case
report. Oral Surgery Oral Medicine Oral
Pathology Oral Radiology and Endodontics 2003;
95: 632-5.
2. Kannan N, Patil R, Sreenivasalu P. Bilateral
Maxillary Dentigerous Cysts A Case Report.
International Journal of Dental Clinics2010;
2(1):28-32.
3. Naclério Homem MG, Simões WA, Zindel
Deboni MC, Chilvarquer I, Traina AA.
Dentigerous cyst associated with an upper
permanent central incisor: case report and
literature review. Journal of Clinical Pediatric
Dentistry 2003;27(2):187-92.
4. Daley TD, Wysocki GP. The small dentigerous
cyst: A diagnostic dilemma. Oral Surgery, Oral
Medicine, Oral Pathology, Oral Radiology and
Endodontology 1995;79(1):77-81.
5. Lustmann J, Bodner L. Dentigerous cysts
associated with supernumerary teeth.
International Journal of Oral And Maxillofacial
Surgery 1988;17(2):100-2.
6. Desai R, Vanaki S, Puranik R, Tegginamani A.
Dentigerous cyst associated with permanent
central incisor: A rare entity. Journal of Indian
Society of Pedodontics and Preventive Dentistry
2005; 23(1):49-50.
Address for Correspondence
Dr. Chandramani. B. M.,M.D.S .,
Professor & Head,
Department of Oral Medicine & Radiology,
K. M. Shah Dental College & Hospital,
Sumandeep University,
Vadodara,Gujarat, India.
Email: drchandramanimore@rediffmail.com
Source of Support: Nil, Conflict of Interest: None Declared
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